MEDICARE: PEARSONS DISCOUNT DRUGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	1679PH	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982730974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARSONS DISCOUNT DRUGS LLC

Provider Business Mailing Address
First Line	:	101 E WASHINGTON ST
Second Line	:
City	:	HOUSTON
State	:	MS
Zip	:	38851-2225
Country	:	US
Telephone Number	:	662-456-2551
Fax Number	:	662-456-3020

Provider Business Practice Location Address
First Line	:	101 E WASHINGTON ST
Second Line	:
City	:	HOUSTON
State	:	MS
Zip	:	38851-2225
Country	:	US
Telephone Number	:	662-456-2551
Fax Number	:	662-456-3020

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	WALTER STEPHEN PEARSON
Credential	:
Telephone Number	:	662-456-2551

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	05/24/2022

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